QAPI 121 - Closed Systems: are Conventional Arterial Line Monitoring and Sampling Systems Contributing to Central Line Associated Bloodstream Infections (CLABSI(s)?

Background: Arterial catheters are commonly used in the critical care setting to monitor blood pressure and obtain blood samples making them among the most heavily manipulated vascular access devices. Frequent accesses can lead to higher blood contamination rates, bacteremias, and antibiotic administration. Many of these patients also have other central vascular accesses that are at risk of microbial contamination and colonization. Because of an increase in central line associated bloodstream infections in patients with both arterial and venous catheters a closed arterial monitoring/sampling system was implemented.

Methods: Bloodstream infections meeting identified criteria between July 2021 and October 2023 were included in this root cause analysis. A CLABSI was defined as a positive blood culture collected from a patient located in the surgical and medical critical care units with both an arterial and central venous catheter that met the National Healthcare Safety Network (NHSN) primary bloodstream infection definition.

Results: Twenty – eight months of data were analyzed for each of the two critical care units in the hospital. Twenty – one patients met criteria out of 3818 central line days. A spike in CLABSIs was noted beginning November 2021 through February 2022. Following implementation of an education blitz for the critical care nursing staff that focused on central line maintenance best practices, daily chlorhexidine bathing, and strict hand hygiene practices, the CLABSI numbers in the critical care units in February 2022 showed a slight decrease in infections but had variable sustainability. However, a sustained decrease in the number of CLABSIs was noted following implementation of a closed arterial monitoring/sampling system.

Conclusions: The use of a closed arterial monitoring/sampling system along with proper line maintenance, daily chlorhexidine bathing, and strict hand hygiene practices reduced the incidence of CLABSIs in patients within the surgical and medical critical units by 94% in an 8-month period.